Consumer Wearables for Patient Monitoring in Otolaryngology: A State of the Art Review

2021 ◽  
pp. 019459982110616
Author(s):  
Shaan N. Somani ◽  
Katherine M. Yu ◽  
Alexander G. Chiu ◽  
Kevin J. Sykes ◽  
Jennifer A. Villwock
Keyword(s):  
Health Care ◽  
Clinical Outcomes ◽  
Behavioral Interventions ◽  
Early Recognition ◽  
Clinical Care ◽  
The United States ◽  
Major Surgery ◽  
Inpatient Setting ◽  
Biometric Data ◽  
Pubmed Search

Objective Consumer wearables, such as the Apple Watch or Fitbit devices, have become increasingly commonplace over the past decade. The application of these devices to health care remains an area of significant yet ill-defined promise. This review aims to identify the potential role of consumer wearables for the monitoring of otolaryngology patients. Data Sources PubMed. Review Methods A PubMed search was conducted to identify the use of consumer wearables for the assessment of clinical outcomes relevant to otolaryngology. Articles were included if they described the use of wearables that were designed for continuous wear and were available for consumer purchase in the United States. Articles meeting inclusion criteria were synthesized into a final narrative review. Conclusions In the perioperative setting, consumer wearables could facilitate prehabilitation before major surgery and prediction of clinical outcomes. The use of consumer wearables in the inpatient setting could allow for early recognition of parameters suggestive of poor or declining health. The real-time feedback provided by these devices in the remote setting could be incorporated into behavioral interventions to promote patients’ engagement with healthy behaviors. Various concerns surrounding the privacy, ownership, and validity of wearable-derived data must be addressed before their widespread adoption in health care. Implications for Practice Understanding how to leverage the wealth of biometric data collected by consumer wearables to improve health outcomes will become a high-impact area of research and clinical care. Well-designed comparative studies that elucidate the value and clinical applicability of these data are needed.

Feasibility, Benefits, and Limitations of a Penicillin Allergy Skin Testing Service

2017 ◽  
Vol 51 (6) ◽  
pp. 504-510 ◽  
Author(s):  
Prasanna P. Narayanan ◽  
Meghan N. Jeffres
Keyword(s):  
Health Care ◽  
Clinical Outcomes ◽  
English Language ◽  
Data Extraction ◽  
Financial Burden ◽  
Skin Testing ◽  
The United States ◽  
Multidrug Resistant ◽  
Penicillin Allergy ◽  
Testing Service

Objective: To critically examine the feasibility, benefits, and limitations of an inpatient penicillin skin testing service and how pharmacists can be utilized. Data Sources: A PubMed search was performed from July 2016 through September 2016 using the following search terms: penicillin skin testing, penicillin allergy, β-lactam allergy. Additional references were identified from a review of literature citations. Study Selection and Data Extraction: All English-language studies assessing the use of penicillin skin testing as well as management and clinical outcomes of patients with a β-lactam allergy were evaluated. Data Synthesis: The prevalence of people self-identifying as penicillin allergic ranges from 10% to 20% in the United States. Being improperly labeled as penicillin allergic is associated with higher health care costs, worse clinical outcomes, and an increased prevalence of multidrug-resistant infections. Penicillin skin testing can be a tool used to clarify penicillin allergies and has been demonstrated to be a successful addition to antimicrobial stewardship programs in multiple health care settings. Prior to implementing a penicillin skin testing service, institutions will need to perform a feasibility analysis of who will supply labor and accept the financial burden as well as identify if the positive benefits of a penicillin skin testing service overcome the limitations of this diagnostic test. Conclusion: We conclude that institutions with high percentages of patients receiving non–β-lactams because of penicillin allergy labels would likely benefit the most from a penicillin skin testing service.

scholarly journals An International Survey of Health Care Services Available to Patients With Tourette Syndrome

2021 ◽  
Vol 12 ◽  
Author(s):  
Tracy Bhikram ◽  
Rana Elmaghraby ◽  
Elia Abi-Jaoude ◽  
Paul Sandor
Keyword(s):  
Health Care ◽  
Tourette Syndrome ◽  
Health Care Services ◽  
Treatment Guidelines ◽  
Care Delivery ◽  
Clinical Care ◽  
Health Service Delivery ◽  
The United States ◽  
Dopamine Receptor Antagonists ◽  
Geographical Regions

Objective: Tourette syndrome (TS) is a neuropsychiatric disorder that is highly associated with several comorbidities. Given the complex and multifaceted nature of TS, the condition is managed by a wide variety of practitioners in different disciplines. The goal of this study was to investigate health service delivery and care practices by clinicians who see TS patients across different geographic settings internationally.Methods: A comprehensive questionnaire was developed to assess clinical care resources for patients with TS and was sent to clinicians in Canada (CA), the United States (US), Europe (EU), and the United Kingdom (UK). Responses were compared quantitatively between geographic regions.Results: The majority of respondents, regardless of region, reported that fewer than 40% of their case-load are patients with tics. The accessibility of TS services varied among regions, as indicated by differences in wait times, telemedicine offerings, comorbidity management and the availability of behavioral therapies. First-line pharmacotherapy preferences varied among physicians in different geographical regions with CA respondents preferring alpha-2-adrenergic agonists and respondents from the UK and EU preferring dopamine receptor antagonists.Discussion: The results suggest that there is a scarcity of specialized TS clinics, potentially making access to services challenging, especially for patients newly diagnosed with TS. Differences in regional pharmacotherapeutic preferences are reflected in various published treatment guidelines in EU and North America. The lack of dedicated specialists and telemedicine availability, coupled with differences in comorbidity management, highlight the need for interprofessional care and holistic management to improve health care delivery to patients with TS.

scholarly journals Factors Affecting the Implementation of Electronic Antiretroviral Therapy Adherence Monitoring and Associated Interventions for Routine HIV Care in Uganda: Qualitative Study

10.2196/18038 ◽  
2020 ◽  
Vol 22 (9) ◽  
pp. e18038
Author(s):  
Jessica E Haberer ◽  
Lindsey Garrison ◽  
John Bosco Tumuhairwe ◽  
Robert Baijuka ◽  
Edna Tindimwebwa ◽  
...  
Keyword(s):  
Health Care ◽  
Antiretroviral Therapy ◽  
Clinical Outcomes ◽  
Care Delivery ◽  
Low Cost ◽  
Clinical Care ◽  
Hiv Care ◽  
Health Care Administrators ◽  
Adherence Monitoring ◽  
Data Informed

Background High, sustained adherence to HIV antiretroviral therapy (ART) is critical for achieving viral suppression, which in turn leads to important individual health benefits and reduced secondary viral transmission. Electronic adherence monitors record a date-and-time stamp with each opening as a proxy for pill-taking behavior. These monitors can be combined with interventions (eg, data-informed adherence counseling, SMS-based adherence support, and/or alarms) and have been shown to improve adherence in multiple settings. Their use, however, has largely been limited to the research context. Objective The goal of the research was to use the Consolidated Framework for Implementation Research (CFIR) to understand factors relevant for implementing a low-cost electronic adherence monitor and associated interventions for routine HIV clinical care in Uganda. Methods We conducted in-depth qualitative interviews with health care administrators, clinicians, and ART clients about likes and dislikes of the features and functions of electronic adherence monitors and associated interventions, their potential to influence HIV care, suggestions on how to measure their value, and recommendations for their use in routine care. We used an inductive, content analysis approach to understand participant perspectives, identifying aspects of CFIR most relevant to technology implementation in this setting. Results We interviewed 34 health care administrators/clinicians and 15 ART clients. Participants largely saw the monitors and associated interventions as favorable and beneficial for supporting adherence and improving clinical outcomes through efficient, differentiated care. Relevant outside factors included structural determinants of health, international norms around supporting adherence, and limited funding that necessitates careful assessment of costs and benefits. Within the clinic, the adherence data were felt likely to improve the quality of counseling and thereby morale, as well as increase the efficiency of care delivery. Existing infrastructure and care expenditures and the need for proper training were other noted considerations. At the individual level, the desire for good health and a welcomed pressure to adhere favored uptake of the monitors, although some participants were concerned with clients not using the monitors as planned and the influence of poverty, stigma, and need for privacy. Finally, participants felt that decisions around the implementation process would have to come from the Ministry of Health and other funders and would be influenced by sustainability of the technology and the target population for its use. Coordination across the health care system would be important for implementation. Conclusions Low-cost electronic adherence monitoring combined with data-informed counseling, SMS-based support, and/or alarms have potential for use in routine HIV care in Uganda. Key metrics of successful implementation will include their impact on efficiency of care delivery and clinical outcomes with careful attention paid to factors such as stigma and cost. Further theory-driven implementation science efforts will be needed to move promising technology from research into clinical care. Trial Registration ClinicalTrials.gov NCT03825952; https://clinicaltrials.gov/ct2/show/NCT03825952

scholarly journals Pregnancy-Related Acute Kidney Injury in the United States: Clinical Outcomes and Health Care Utilization

2020 ◽  
Vol 51 (3) ◽  
pp. 216-226 ◽  
Author(s):  
Silvi Shah ◽  
Karthikeyan Meganathan ◽  
Annette L. Christianson ◽  
Kathleen Harrison ◽  
Anthony C. Leonard ◽  
...  
Keyword(s):  
Health Care ◽  
Acute Kidney Injury ◽  
Health Care Utilization ◽  
Clinical Outcomes ◽  
Kidney Injury ◽  
The United States ◽  
Care Utilization ◽  
Inpatient Mortality ◽  
Factors Associated ◽  
Race Ethnicity

Background: Acute kidney injury (AKI) during pregnancy is a public health problem and is associated with maternal and fetal morbidity and mortality. Clinical outcomes and health care utilization in pregnancy-related AKI, especially in women with diabetes, are not well studied. Methods: Using data from the 2006 to 2015 Nationwide Inpatient Sample, we identified 42,190,790 pregnancy-related hospitalizations in women aged 15–49 years. We determined factors associated with AKI, including race/ethnicity, and associations between AKI and inpatient mortality, and between AKI and cardiovascular (CV) events, during pregnancy-related hospitalizations. We calculated health care expenditures from pregnancy-related AKI hospitalizations. Results: Overall, the rate of AKI during pregnancy-related hospitalizations was 0.08%. In the adjusted regression analysis, a higher likelihood of AKI during pregnancy-related hospitalizations was seen in 2015 (OR 2.20; 95% CI 1.89–2.55) than in 2006; in older women aged 36–40 years (OR 1.49; 95% CI 1.36–1.64) and 41–49 years (OR 2.12; 95% CI 1.84–2.45) than in women aged 20–25 years; in blacks (OR 1.52; 95% CI 1.40–1.65) and Native Americans (OR 1.45; 95% CI 1.10–1.91) than in whites, and in diabetic women (OR 4.43; 95% CI 4.04–4.86) than in those without diabetes. Pregnancy-related hospitalizations with AKI were associated with a higher likelihood of inpatient mortality (OR 13.50; 95% CI 10.47–17.42) and CV events (OR 9.74; 95% CI 9.08–10.46) than were hospitalizations with no AKI. The median cost was higher for a delivery hospitalization with AKI than without AKI (USD 18,072 vs. 4,447). Conclusion: The rates of pregnancy-related AKI hospitalizations have increased during the last decade. Factors associated with a higher likelihood of AKI during pregnancy included older age, black and Native American race/ethnicity, and diabetes. Hospitalizations with pregnancy-related AKI have an increased risk of inpatient mortality and CV events, and a higher health care utilization than do those without AKI.

scholarly journals Factors Affecting the Implementation of Electronic Antiretroviral Therapy Adherence Monitoring and Associated Interventions for Routine HIV Care in Uganda: Qualitative Study (Preprint)

2020 ◽  
Author(s):  
Jessica E Haberer ◽  
Lindsey Garrison ◽  
John Bosco Tumuhairwe ◽  
Robert Baijuka ◽  
Edna Tindimwebwa ◽  
...  
Keyword(s):  
Health Care ◽  
Antiretroviral Therapy ◽  
Clinical Outcomes ◽  
Care Delivery ◽  
Low Cost ◽  
Clinical Care ◽  
Hiv Care ◽  
Health Care Administrators ◽  
Adherence Monitoring ◽  
Data Informed

BACKGROUND High, sustained adherence to HIV antiretroviral therapy (ART) is critical for achieving viral suppression, which in turn leads to important individual health benefits and reduced secondary viral transmission. Electronic adherence monitors record a date-and-time stamp with each opening as a proxy for pill-taking behavior. These monitors can be combined with interventions (eg, data-informed adherence counseling, SMS-based adherence support, and/or alarms) and have been shown to improve adherence in multiple settings. Their use, however, has largely been limited to the research context. OBJECTIVE The goal of the research was to use the Consolidated Framework for Implementation Research (CFIR) to understand factors relevant for implementing a low-cost electronic adherence monitor and associated interventions for routine HIV clinical care in Uganda. METHODS We conducted in-depth qualitative interviews with health care administrators, clinicians, and ART clients about likes and dislikes of the features and functions of electronic adherence monitors and associated interventions, their potential to influence HIV care, suggestions on how to measure their value, and recommendations for their use in routine care. We used an inductive, content analysis approach to understand participant perspectives, identifying aspects of CFIR most relevant to technology implementation in this setting. RESULTS We interviewed 34 health care administrators/clinicians and 15 ART clients. Participants largely saw the monitors and associated interventions as favorable and beneficial for supporting adherence and improving clinical outcomes through efficient, differentiated care. Relevant outside factors included structural determinants of health, international norms around supporting adherence, and limited funding that necessitates careful assessment of costs and benefits. Within the clinic, the adherence data were felt likely to improve the quality of counseling and thereby morale, as well as increase the efficiency of care delivery. Existing infrastructure and care expenditures and the need for proper training were other noted considerations. At the individual level, the desire for good health and a welcomed pressure to adhere favored uptake of the monitors, although some participants were concerned with clients not using the monitors as planned and the influence of poverty, stigma, and need for privacy. Finally, participants felt that decisions around the implementation process would have to come from the Ministry of Health and other funders and would be influenced by sustainability of the technology and the target population for its use. Coordination across the health care system would be important for implementation. CONCLUSIONS Low-cost electronic adherence monitoring combined with data-informed counseling, SMS-based support, and/or alarms have potential for use in routine HIV care in Uganda. Key metrics of successful implementation will include their impact on efficiency of care delivery and clinical outcomes with careful attention paid to factors such as stigma and cost. Further theory-driven implementation science efforts will be needed to move promising technology from research into clinical care. CLINICALTRIAL ClinicalTrials.gov NCT03825952; https://clinicaltrials.gov/ct2/show/NCT03825952

scholarly journals Use of Telehealth During the COVID-19 Pandemic: Scoping Review

10.2196/24087 ◽  
2020 ◽  
Vol 22 (12) ◽  
pp. e24087
Author(s):  
Sathyanarayanan Doraiswamy ◽  
Amit Abraham ◽  
Ravinder Mamtani ◽  
Sohaila Cheema
Keyword(s):  
Health Care ◽  
Scoping Review ◽  
Data Privacy ◽  
Clinical Care ◽  
The United States ◽  
High Income ◽  
Journal Title ◽  
Publication Type ◽  
Medical Specialties ◽  
The Impact

Background With over 37.8 million cases and over 1 million deaths worldwide, the COVID-19 pandemic has created a societal and economic upheaval of unparalleled magnitude. A positive transformation has been brought about by innovative solutions in the health care sector that aim to mitigate the impact of COVID-19 on human health. For instance, the use of telehealth has been on the rise amidst this public health emergency. Objective Given the unprecedented scale of the pandemic with no definitive endpoint, we aimed to scope the existing telehealth-related literature during a defined period of the ongoing pandemic (ie, January to June 2020). Methods Our scoping review was guided by the Joanna Briggs Institute Reviewer Manual. We systematically searched PubMed and Embase databases with specific eligibility criteria. Data extracted from the shortlisted articles included first author and affiliation, journal title, publication type, terminologies used to describe telehealth and their accompanying definitions, health discipline or medical specialties and subspecialties wherein telehealth had been applied, the purpose of telehealth use, and the authors’ overall sentiment on telehealth use. We collated the available information and used descriptive statistics to analyze the synthesized data. Results In all, 543 articles published across 331 different journals were included in this scoping review. The Journal of Medical Internet Research and its sister journals featured the highest number of articles (25/543, 4.6%). Nearly all (533/543, 98.2%) articles were in English. The majority of the articles were opinions, commentaries, and perspectives (333/543, 61.3%). Most authors of the articles reviewed were from high-income countries (470/543, 86.6%), especially from the United States of America (237/543, 43.6%). In all, 39 different definitions were used to describe terms equivalent to telehealth. A small percentage (42/543, 7.7%) of the articles focused on the provision of COVID-19–related care. Moreover, 49.7% (270/543) of the articles primarily focused on the provision of multiple components of clinical care, and 23% (125/543) of the articles focused on various specialties and subspecialties of internal medicine. For a vast majority (461/543, 84.9%) of the articles, the authors expressed a celebratory sentiment about the use of telehealth. Conclusions This review identified considerable emerging literature on telehealth during the first six months of the COVID-19 pandemic, albeit mostly from high-income countries. There is compelling evidence to suggest that telehealth may have a significant effect on advancing health care in the future. However, the feasibility and application of telehealth in resource-limited settings and low- and middle-income countries must be established to avail its potential and transform health care for the world’s population. Given the rapidity with which telehealth is advancing, a global consensus on definitions, boundaries, protocols, monitoring, evaluation, and data privacy is urgently needed.

scholarly journals Breast Cancer Screening and the COVID-19 Pandemic

2020 ◽  
Author(s):  
Dana H Smetherman
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Cancer Screening ◽  
Breast Cancer Screening ◽  
Clinical Care ◽  
The United States ◽  
Screening Mammography ◽  
Imaging Studies ◽  
National Organizations ◽  
Screening Mammograms

Abstract The novel SARS-CoV2 (COVID-19) pandemic has had a major impact on breast radiology practices. Initially, nonessential imaging studies, including screening mammography, were curtailed and even temporarily halted when lockdowns were instituted in many parts of the United States. As a result, imaging volumes plummeted while health care institutions worked to ensure safety measures were in place to protect patients and personnel. As COVID-19 infection levels started to stabilize in some areas, breast radiology practices sought guidance from national organizations, such as the Centers for Disease Control and Prevention, the Centers for Medicare and Medicaid Services, and radiology specialty societies, to develop strategies for patients to safely return for screening mammograms and other outpatient imaging studies. Postponement of breast cancer screening has led to delays in cancer diagnosis and treatment that could negatively affect patient outcomes for years to come. In order to continue to provide necessary imaging services, breast radiologists will need to face and overcome ongoing practical challenges related to the pandemic, such as negative financial impacts on practices and patients, the need for modifications in delivery of imaging services and trainee education, and differences in the health care system as a whole, including the shift to telehealth for clinical care. Nonetheless, despite the disruption the COVID-19 pandemic has caused, the need for breast radiology procedures, including breast cancer screening, remains strong.

scholarly journals Use of Telehealth During the COVID-19 Pandemic: Scoping Review (Preprint)

2020 ◽  
Author(s):  
Sathyanarayanan Doraiswamy ◽  
Amit Abraham ◽  
Ravinder Mamtani ◽  
Sohaila Cheema
Keyword(s):  
Health Care ◽  
Scoping Review ◽  
Data Privacy ◽  
Clinical Care ◽  
The United States ◽  
High Income ◽  
Journal Title ◽  
Publication Type ◽  
Medical Specialties ◽  
The Impact

BACKGROUND With over 37.8 million cases and over 1 million deaths worldwide, the COVID-19 pandemic has created a societal and economic upheaval of unparalleled magnitude. A positive transformation has been brought about by innovative solutions in the health care sector that aim to mitigate the impact of COVID-19 on human health. For instance, the use of telehealth has been on the rise amidst this public health emergency. OBJECTIVE Given the unprecedented scale of the pandemic with no definitive endpoint, we aimed to scope the existing telehealth-related literature during a defined period of the ongoing pandemic (ie, January to June 2020). METHODS Our scoping review was guided by the Joanna Briggs Institute Reviewer Manual. We systematically searched PubMed and Embase databases with specific eligibility criteria. Data extracted from the shortlisted articles included first author and affiliation, journal title, publication type, terminologies used to describe telehealth and their accompanying definitions, health discipline or medical specialties and subspecialties wherein telehealth had been applied, the purpose of telehealth use, and the authors’ overall sentiment on telehealth use. We collated the available information and used descriptive statistics to analyze the synthesized data. RESULTS In all, 543 articles published across 331 different journals were included in this scoping review. The Journal of Medical Internet Research and its sister journals featured the highest number of articles (25/543, 4.6%). Nearly all (533/543, 98.2%) articles were in English. The majority of the articles were opinions, commentaries, and perspectives (333/543, 61.3%). Most authors of the articles reviewed were from high-income countries (470/543, 86.6%), especially from the United States of America (237/543, 43.6%). In all, 39 different definitions were used to describe terms equivalent to telehealth. A small percentage (42/543, 7.7%) of the articles focused on the provision of COVID-19–related care. Moreover, 49.7% (270/543) of the articles primarily focused on the provision of multiple components of clinical care, and 23% (125/543) of the articles focused on various specialties and subspecialties of internal medicine. For a vast majority (461/543, 84.9%) of the articles, the authors expressed a celebratory sentiment about the use of telehealth. CONCLUSIONS This review identified considerable emerging literature on telehealth during the first six months of the COVID-19 pandemic, albeit mostly from high-income countries. There is compelling evidence to suggest that telehealth may have a significant effect on advancing health care in the future. However, the feasibility and application of telehealth in resource-limited settings and low- and middle-income countries must be established to avail its potential and transform health care for the world’s population. Given the rapidity with which telehealth is advancing, a global consensus on definitions, boundaries, protocols, monitoring, evaluation, and data privacy is urgently needed.

scholarly journals Real-world treatment patterns and clinical outcomes for inpatients with COVID-19 in the US from September 2020 to February 2021

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261707
Author(s):  
Olulade Ayodele ◽  
Kaili Ren ◽  
Jing Zhao ◽  
James Signorovitch ◽  
Michele Jonsson Funk ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Clinical Improvement ◽  
Unmet Need ◽  
The United States ◽  
Subsequent Treatment ◽  
Treatment Patterns ◽  
Inpatient Setting ◽  
Patient Disposition ◽  
Treatment Use

The objective of this retrospective cohort study was to describe pre-treatment characteristics, treatment patterns, health resource use, and clinical outcomes among adults hospitalized with COVID-19 in the United States (US) who initiated common treatments for COVID-19. The Optum® COVID-19 electronic health records database was used to identify patients >18 years, diagnosed with COVID-19, who were admitted to an inpatient setting and received treatments of interest for COVID-19 between September 2020 and January 2021. Patients were stratified into cohorts based on index treatment use. Patient demographics, medical history, care setting, medical procedures, subsequent treatment use, patient disposition, clinical improvement, and outcomes were summarized descriptively. Among a total of 26,192 patients identified, the most prevalent treatments initiated were dexamethasone (35.4%) and dexamethasone + remdesivir (14.9%), and dexamethasone was the most common subsequent treatment. At day 14 post-index, <10% of patients received any treatments of interest. Mean (standard deviation [SD]) patient age was 65.6 (15.6) years, and the most prevalent comorbidities included hypertension (44.8%), obesity (35.4%), and diabetes (25.7%). At the end of follow-up, patients had a mean (SD) 8.1 (6.6) inpatient days and 1.4 (4.1) days with ICU care. Oxygen supplementation, non-invasive, or invasive ventilation was required by 4.5%, 3.0%, and 3.1% of patients, respectively. At the end of follow-up, 84.2% of patients had evidence of clinical improvement, 3.1% remained hospitalized, 83.8% were discharged, 4% died in hospital, and 9.1% died after discharge. Although the majority of patients were discharged alive, no treatments appeared to alleviate the inpatient morbidity and mortality associated with COVID-19. This highlights an unmet need for effective treatment options for patients hospitalized with COVID-19.

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